锁定加压钢板与带锁髓内钉内固定治疗老年肱骨近端骨质疏松性骨折的疗效比较

Effectiveness comparison between locking compression plate and locked intramedullary nail for osteoporotic proximal humeral fractures in elder people

目的比较锁定加压钢板(locking compression plate,LCP)与带锁髓内钉(locked intramedullary nail,IMN)内固定治疗老年肱骨近端骨质疏松性骨折的临床疗效。方法回顾性分析我院2010年12月至2014年12月收治的47例Neer分型二部分和三部分老年肱骨近端骨质疏松性骨折患者的临床资料,其中29例采用LCP内固定治疗(LCP组),18例采用IMN内固定治疗(IMN组)。两组的年龄、性别、侧别、骨折类型及骨密度等一般资料比较,差异无统计学意义(P>0.05)。比较两组的手术时间、术中出血量、住院时间。根据患者术后是否行抗骨质疏松治疗分为抗骨质疏松治疗组和未抗骨质疏松治疗组;术后是否行康复锻炼分为康复锻炼组和未康复锻炼组。分别于术后3、6、12个月随访患肩的功能,肩关节的术后功能采用Constant-Murley评分进行评估。结果 IMN组手术时间、术中出血量和住院时间均短于LCP组(P<0.05);术后3个月随访结果显示IMN组肩关节功能较LCP组更优(P=0.02),而术后第6和12个月时,两组肩关节功能比较差异无统计学意义(P=0.12,0.31);术后12个月抗骨质疏松治疗组的肩关节功能均明显优于未抗骨质疏松治疗组(P=0.0002);术后6个月随访,康复锻炼组的肩关节功能均明显优于未康复锻炼组(P=0.04)。结论研究结果显示,LCP和IMN在治疗老年肱骨近端骨质疏松性骨折患者中均能取得良好疗效,但IMN组患者早期肩关节功能恢复快;术后抗骨质疏松治疗和规律康复锻炼也是改善肩关节功能的重要因素。

Objective To compare the effectiveness between locking compression plate （ LCP ） and locked intramedullary nail （ IMN ） for osteoporotic proximal humeral fractures （ OPHFs ） in elder people. Methods Between December 2010 and December 2014, 47 patients with OPHFs of Neer II and III types were treated in our hospital. Twenty-nine patients were treated by LCP and 18 patients were treated by IMN. There were no significant differences in age, gender, fracture side, fracture type, and bone mineral density （ BMD ） （ P 〉 0.05 ）. The related outcomes, including operation time, intraoperative blood loss, and hospitalization time, were compared between the 2 groups. The patients were divided into osteoporosis treatment （ OT ） group and osteoporosis non-treatment （ ONT ） group according to osteoporosis treatment, and were classified into rehabilitation group and non-rehabilitation group according to rehabilitation exercise. Shoulder functions were evaluated by Constant-Murley scoring system 3 months, 6 months and 12 months postoperatively. Results Operation time, intraoperative blood loss, and hospitalization time in IMN group were significantly lower than those in LCP group （ P 〈 0.05 ）. The shoulder functions of patients in IMN group were better than that in LCP group 3 months after operation （ P = 0.02 ）. There were no significant differences in the shoulder functions 6 months and 12 months postoperatively （ P = 0.12, 0.31 ）. The shoulder functions of the patients in OT group were better than that in ONT group 12 months postoperatively （ P = 0.0002 ）, and the shoulder functions were better in rehabilitation group than that in non-rehabilitation group 6 months postoperatively （ P = 0.04 ）. Conclusions LCP and IMN can achieve satisfactory results in the treatment of OPHFs, but the recovery of shoulder functions in IMN group is quicker than that in LCP group at early follow-up. Osteoporosis treatment and rehabilitation exercise play important roles in the improvement of shoulder functions.